体外膜肺氧合在心脏移植围术期的应用

目的 总结体外膜肺氧合在心脏移植围术期的临床应用价值。方法 回顾性分析郑州市第七人民医院自2018年4月至2022年12月190例行原位心脏移植术患者临床资料,心脏移植围术期需行ECMO辅助16例,其中1例为心肝联合移植术,诊断为扩张型心肌病9例,缺血性心肌病5例,肥厚型心肌病1例,致心律失常性心肌病1例。建立途径以股动静脉(VA ECMO)为主,ECMO运行流量2.5～4.0 L/min[30～60 mL/(min·kg)], ECMO氧浓度60%～80%,血/气比值维持在1∶0.6～1.5。采用保护性肺通气策略,呼吸机参数设置PEEP5～12 cm H₂O,吸入氧浓度30%～80%,潮气量6～8 mL/kg。变温水箱温度维持在36～37℃。结果 16例心脏移植围术期ECMO患者中。脱机13例(81.3%),痊愈出院10例(62.5%)。ECMO辅助时间中位数97.89(73.54,150.14)h(27～425.45 h),围术期并发症肾功能不全8例,肝功能不全5例,手术部位严重出血3例,溶血3例,下肢并发症3例(下肢肿胀2例,严重肢体缺血坏死1例),血栓形成...     

16例静脉输氧治疗呼吸道梗阻的疗效观察

目的探讨呼吸道梗阻时静脉输氧的治疗价值。方法32例呼吸道梗阻病人随机分成两组,每组16例,两组在年龄、性别及疾病分布上差异无显著性。对照组给以清理呼吸道、气道插管或气管切开呼吸机辅助呼吸等处理。治疗组一经发现呼吸道梗阻即先随液体静脉给以舒氧灵500 ml,并行上述治疗。两组于抢救前、抢救后15、60、180分钟,分别监测HR、R、PaO2 及SaO2,并观察症状体征变化。结果治疗组病人经给以舒氧灵15分钟后HR、R渐减慢, PaO2、SaO2 升高,与治疗前及对照组比较差异有显著性(P<0 01),对照组死亡4例,治疗组无死亡病例。静脉输氧组有1例病人昏迷不醒,呈植物人状态。结论早期静脉输氧在抢救急性呼吸道梗阻时效果明显,值得推广应用。     

七氟醚后处理对体外循环犬肺保护的作用

目的探讨七氟醚后处理对体外循环(CPB)犬肺组织缺血-再灌注损伤(LIRI)的保护作用.方法 健康成年杂种犬12只 ,随机分为两组(n=6) ,左肺缺血再灌注组(C组)、七氟醚后处理组(Y组).两组犬麻醉后行双腔气管插管机械通气 ,股动、静脉穿刺置管测平均动脉压(MAP)及中心静脉压(CVP) ,开胸并建立犬CPB.C组犬左肺行缺血再灌注 ,Y组左肺缺血再灌注后行七氟醚后处理.分别于CPB前(T1)、开放左肺动脉时(T2)及停机后2h(T3)取肺组织 HE染色观察形态学变化并进行病理评分 ,取股动脉血行动脉血气分析并计算氧合指数(OI)、呼吸指数(RI)和动态肺顺应性(Cd).结果 (1)光镜观察 :两组犬肺组织破坏程度随时间推移而增加 ,两组T1、T2 时点肺组织无明显差异 ;T3 时点C组肺组织破坏最为严重 ,Y组肺组织破坏程度明显低于C组 ;(2)病理学评分 :两组T3 时点病理学评分明显高于T1、T2 时间点 ,Y组病理评分明显低于C组(P<0 .05);(3)呼吸参数变化 :随时间推移两组OI和Cd明显降低而RI明显升高 ,T3 时间点Cd和OI ,Y组明显高于C组(P<0.05) ,而RI ,Y组明显低于C组(P<0.05).结论七氟醚后处理可提高体外循环犬的OI、Cd ,降低犬RI ,对犬体外循环导致的肺损伤有一定的保护作用.     

体外膜肺氧合下儿童抗感染治疗最新研究现状

体外膜肺氧合(ECMO)作为一种医疗急救设备,用于心肺功能衰竭时为患者提供体外的呼吸与循环生命支持,以维持危重患者生命.目前,随着ECMO技术逐渐成熟,ECMO在儿科领域的应用也日益广泛,尤其用于心肺功能不全的危重症患儿的辅助支持治疗.应用ECMO的患者常伴有严重感染的发生,然而ECMO会影响部分抗感染药物的体内过程,...     

股静脉与颈内静脉半永久双腔导管在血液透析中的应用

目的:比较股静脉与颈内静脉半永久双腔导管在血液透析中的使用情况。方法:采用前瞻性研究,将50例不能建立动静脉内瘘的患者分为两组:颈内静脉组31例,将半永久性双腔导管留置于颈内静脉;股静脉组19例,将半永久性双腔导管留置于股静脉。观察两组患者导管使用寿命、并发症、透析血流量及Kt/V值等指标。结果:颈内静脉组导管使用寿命为(387±101)天,而股静脉组为(210±88)天,差异有显著性(P<0.05);两组的透析血流量与Kt/V值差异无显著性。结论:对不能建立动静脉内瘘的患者,股静脉及颈内静脉半永久性双腔导管是较好的血管通路,颈内静脉优于股静脉。     

体外膜肺氧合对抗真菌药物药动学的影响

体外膜肺氧合(ECMO)是一种体外循环装置,用于支持顽固性呼吸和(或)心力衰竭患者,延长其心肺功能时间。接受ECMO的通常是重症监护病房(ICU)中病情严重患者,由于经常应用广谱抗菌药物、免疫系统受损以及接受插管等原因,容易受到真菌的侵袭和感染。临床上常用的抗真菌药物种类繁多,而ECMO很容易对药物的药动学(PK)产生影响。该文就ECMO对抗真菌药物PK的影响进行讨论,为合并真菌感染ECMO患者的抗真菌治疗提供参考。     

体外模式氧合对抗感染药物的药代动力学影响及常用药物剂量

体外模式氧合(Extracorporeal membrane oxygenation,ECMO)是一种医疗急救技术设备,主要用于对重症心肺功能衰竭患者提供持续的体外呼吸与循环,以维持患者生命.目前,新型冠状病毒肺炎疫情形势严峻,为降低新冠肺炎危重患者的病死率,临床已针对性地开展ECMO应用.然而ECMO的应用会对药物的...     

体外膜肺氧合联合主动脉内气囊反搏治疗成人急性心脏功能衰竭

目的 探讨体外膜肺氧合(ECMO)联合主动脉内气囊反搏(IABP)治疗成人急性心脏功能衰竭的效果.方法 回顾2008年1月至2012年7月因急性心脏功能衰竭接受ECMO联合IABP治疗的成年患者54例的临床资料.单纯CABG 28例,CABG加瓣膜手术6例,CABG加室壁瘤成型6例,CABG加房颤射频消融术2例,CABG加室间隔穿孔修补2例,瓣膜手术8例,心脏移植1例,暴发性心肌炎1例.先行置入IABP后循环仍然不能维持,后放置ECMO辅助的患者39例,先行置入ECMO后因左心室后负荷增加、主动脉瓣开放受限放置IABP辅助的患者15例.52例患者经股动静脉插管建立ECMO,2例经股静脉-升主动脉插管建立ECMO,并经另一侧股动脉插管建立IABP.辅助期间应用肝素全身抗凝.结果 34例(63%)患者成功脱离机械辅助,21例(38.9%)存活出院.主要并发症为肾功能衰竭需要透析32例、感染23例、氧合器血浆渗漏19例、出血18例、肢体缺血8例、中枢神经系统并发症4例.结论 体外膜式氧合与主动脉内气囊反搏可相互协同、作用互补,及时放置并积极预防、治疗并发症可以提高急性心脏功能衰竭患者的抢救成功率.     

体外膜肺氧合治疗重症心脏病的护理

体外膜肺氧合(ECMO)是指将患者静脉血引流至体外,经氧合器后再输回动脉或静脉的中短期心肺辅助治疗,使心肺得到充分休息,为心肺功能恢复赢得时间[1].当重症心脏病患者,应用传统机械通气技术,血管活性药物治疗,出现难以控制的心肺功能障碍时,ECMO以其有效的呼吸循环支持,满足机体重要脏器和组织氧合需求,显示出明显优势.     

静脉应用胺碘酮转复持续性房颤

目的观察静脉应用胺碘酮转复持续性心房颤动(LastAtrialFibrillation以下简称LAF)的有效性及安全性。方法收集了51例LAF患者经静脉应用胺碘酮转复治疗,首剂静脉注射3mg/kg,接着以1.5mg/mim静滴维持12h,再以0.7～1mg/min维持36h。结果静脉注射胺碘酮转复LAF成功率88%,不良反应发生率7.8%。结论静脉应用胺碘酮转复LAF成功率高、安全、副作用小。     

Industrial separation of oxygen isotopes by oxygen distillation

¹⁸O‐labeled water (Water‐¹⁸O) is a widely used starting material of ¹⁸F‐labeled diagnostic agents in positron emission tomography (PET). Conventionally, Water‐¹⁸O has been separated from other stable oxygen isotope species (¹⁶O, ¹⁷O) by water distillation or nitric oxide distillation. However, conventional methods are costly and may have safety issues. In 2004, we developed the first unit of our novel oxygen isotope separation process by cryogenic oxygen distillation to overcome these issues. To meet the needs of the market, we built a second unit in 2013 and a third in 2016. We are now operating three commercially viable separation units with a total capacity of 600 kg of Water‐¹⁸O per year.     

Haemoglobin-based oxygen carriers

Haemoglobin-based oxygen carriers are being developed for use in blood replacement therapies, either for perioperative haemodilution or for resuscitation from haemorrhagic blood loss. There is a high demand for these products because of risks associated with blood transfusions and pending worldwide blood shortages. Development of these products has required new technologies in protein engineering; since the haemoglobin is cell-free in solution, the molecule must be modified to be retained within blood circulation. Three classes of haemoglobin are under development: intramolecular cross-linked, intermolecular polymerised and surface conjugated with polyethylene glycol. Two products based on cross-linking chemistry have been discontinued because of serious adverse events and/or increased mortality rate in Phase III clinical trials. Three products based on polymerisation chemistry are in ongoing Phase III clinical trials. A new product based on surface conjugation is in preclinical evaluation. Although cross-linked and polymerised products have shown to be safe in preclinical and early Phase I/II clinical trials, they have had difficulty in proving efficacy. The primary adverse effect for the majority of cross-linked or polymerised products is a haemodynamic response, leading to increased vascular resistance to blood flow. The physiological mechanisms are still incompletely understood, so that safety and efficacy cannot be completely dissociated. New understandings on the mode of action of these products will help to define their utility and application. New products are under development, designed specifically to maximise blood flow and tissue perfusion and therefore, oxygenation.     

Reactivity of various phenothiazine derivatives with oxygen and oxygen radicals

7,8-Dihydroxychlorpromazine, 7,8-dihydroxyprochlorperazine and 7,8-dihydroxyperphenazine all reacted with O₂ to make hydrogen peroxide (H₂O₂). The rate of reaction between the ortho-dihydroxyphenothiazines and O₂ was increased by superoxide dismutase, an enzyme which catalyzes the dismutation of the superoxide radical (O₂^?) to H₂O₂ and O₂. This indicated the formation of O₂^? during the autoxidation of the ortho-dihydroxyphenothiazines. Several phenothiazines lacking the ortho-dihydroxy groups did not consume O₂ at a detectable rate (did not generate H₂O₂). All ortho-dihydroxyphenothiazines tested also reacted with O₂ in the presence of methional to form ethylene. Ethylene formation was inhibited by catalase and hydroxyl radical (·OH) trapping agents, such as sodium benzoate; this indicated ·OH formation from the ortho-dihydroxyphenothiazines. In addition, several nonhydroxylated phenothiazines and monohydroxylated phenothiazines inhibited ethylene generation from 6-aminodopamine, which also generates ·OH. This inhibition was probably mediated by a reaction between the phenothiazine and ·OH. All of the above reactions (generation of H₂O₂, O₂^? or ·OH or reaction with ·OH) may be responsible for some of the beneficial and/or adverse effects of administered phenothiazines.     

Haemoglobin-based oxygen carriers

Haemoglobin-based oxygen carriers are being developed for use in blood replacement therapies, either for perioperative haemodilution or for resuscitation from haemorrhagic blood loss. There is a high demand for these products because of risks associated with blood transfusions and pending worldwide blood shortages. Development of these products has required new technologies in protein engineering; since the haemoglobin is cell-free in solution, the molecule must be modified to be retained within blood circulation. Three classes of haemoglobin are under development: intramolecular cross-linked, intermolecular polymerised and surface conjugated with polyethylene glycol. Two products based on cross-linking chemistry have been discontinued because of serious adverse events and/or increased mortality rate in Phase III clinical trials. Three products based on polymerisation chemistry are in ongoing Phase III clinical trials. A new product based on surface conjugation is in preclinical evaluation. Although cross-linked and polymerised products have shown to be safe in preclinical and early Phase I/II clinical trials, they have had difficulty in proving efficacy. The primary adverse effect for the majority of cross-linked or polymerised products is a haemodynamic response, leading to increased vascular resistance to blood flow. The physiological mechanisms are still incompletely understood, so that safety and efficacy cannot be completely dissociated. New understandings on the mode of action of these products will help to define their utility and application. New products are under development, designed specifically to maximise blood flow and tissue perfusion and therefore, oxygenation.